Subacute Testicular Torsion Initially Diagnosed As Epididymitis: MRI and Contrast-Enhanced Ultrasound Findings of Complete Testicular Infarction

Testicular torsion is a time-critical urological emergency; however, atypical and subacute presentations may mimic epididymitis and delay diagnosis.We present the case of a 19-year-old man who initially presented with gradual-onset left testicular pain and was diagnosed with epididymitis based on clinical and ultrasound findings.Despite antibiotic therapy, he re-presented five days later with worsening pain and elevated inflammatory markers.At a surgical ambulatory clinic review approximately two weeks after initial presentation, his symptoms had partially resolved, and his antibiotic course was extended.However, followup ultrasound at three months demonstrated a heterogeneous, solid-appearing epididymal mass and diffusely abnormal testicular echotexture, raising concern for vascular compromise.Subsequent MRI demonstrated features of hemorrhagic infarction and a whirlpool sign, while contrast-enhanced ultrasound demonstrated complete absence of intratesticular perfusion, consistent with complete testicular infarction.At this point, the patient was asymptomatic and was managed conservatively.This case highlights the diagnostic challenges of subacute torsion, the limitations of initial ultrasound, the role of advanced imaging in equivocal cases, and the importance of multidisciplinary management and long-term counseling in conservatively managed patients.